Patterns and Outcomes of Neurosurgery in England Over a Five-year Period

Patterns and Outcomes of Neurosurgery in England Over a Five-year Period: a National Retrospective Cohort Study

Neurosurgical practice has seen many important changes over several decades with advances in treatments and the types of patients treated. Neurosurgical procedures have evolved, and as outcomes have improved the number of patients being treated has increased.

There are no recent evaluations of national neurosurgical practice in the United Kingdom (UK), with the last prospective cohort studies being Safe Neurosurgery 1993 and Safe Neurosurgery 2000. More recent studies of neurosurgical services have been based on data from single institutions or surgeons and these may not give a representative picture of practice nationally.

Recent national quality improvement programmes for neurosurgery in England (such as the National Neurosurgical Audit Programme (NNAP) and Cranial Neurosurgery and Spinal Surgery Getting It Right First Time (GIRFT) Programmes) have focused on using national hospital administrative datasets. To be effective, quality improvement initiatives require robust outcome measures and quality (process) indicators. Currently, there is a lack of validated quality indicators for neurosurgery, with practice often being described using generic measures such as readmission and reoperation rates and length of stay. Many studies have been able to derive these common outcome measures, but it may also be possible to produce indicators specific to neurosurgery.

The aim of this observational study was firstly to describe the current pattern of neurosurgical admissions and procedures in England, and thereby given an overview of the epidemiology of neurosurgical patients. Secondly, it aims to investigate the range of outcome measures that might be produced from hospital administrative data and use these to assess the quality of care in neurosurgery.

Study Overview

• Status: Completed
• Conditions: Surgery; Surgery--Complications; Outcome, Fatal; Neurological Disorder; Morality; Neurological Morbidity; Neurological Complication; Comorbidities and Coexisting Conditions; Neurological Diseases or Conditions; Neurological Procedural Complication
• Intervention / Treatment: Procedure: Neurosurgical procedure

• Study Type: Observational
• Enrollment (Actual): 371418

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All admissions to neurosurgical units in the National Health Service (NHS) in England. This covers any patients in England who required neurosurgical care, except those admitted to Private Providers of neurosurgical care.

Description

Inclusion Criteria:

• All admissions to neurosurgical units in the National Health Service (NHS) in England.

Exclusion Criteria:

• Records with poor quality data (e.g. no data for clinical diagnoses).
• Patients under 18 years that were admitted to an adult neurosurgical unit.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Elective neurosurgery; Any elective neurosurgical procedure.	Procedure: Neurosurgical procedure; Any neurosurgical procedure in the National Neurosurgical Audit Programme (NNAP) Coding Framework of neurosurgical procedures.
Non-elective neurosurgery; Any non-elective neurosurgical procedure.	Procedure: Neurosurgical procedure; Any neurosurgical procedure in the National Neurosurgical Audit Programme (NNAP) Coding Framework of neurosurgical procedures.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of stay	Length of the hospital admission to neurosurgery	From date of admission to date of discharge from hospital; assessed up to 60 months.
Additional inpatient neurosurgical procedure rate	A further neurosurgical procedure in admissions where patients have had a primary (main) neurosurgical procedure.	From date of admission to date of discharge from hospital; assessed up to 60 months.
Proportion of patients discharged home	Proportion of patients discharged to their normal address.	Determined on date of discharge from hospital; assessed up to 60 months.
In-patient mortality rate	In-patient mortality after a neurosurgical procedure.	From date of the neurosurgical procedure through date of death from any cause (in-patient deaths only); assessed up to 60 months.

Collaborators and Investigators

• Sponsor: University of Leeds
• Collaborators: The Royal College of Surgeons of England
• Investigators: Study Chair: Ryan Mathew, University of Leeds

Study record dates

Study Major Dates

• Study Start (ACTUAL): April 1, 2013
• Primary Completion (ACTUAL): March 31, 2018
• Study Completion (ACTUAL): March 31, 2018

Study Registration Dates

• First Submitted: September 14, 2021
• First Submitted That Met QC Criteria: October 14, 2021
• First Posted (ACTUAL): October 27, 2021

Study Record Updates

• Last Update Posted (ACTUAL): October 27, 2021
• Last Update Submitted That Met QC Criteria: October 14, 2021
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Nervous System Diseases
• Other Study ID Numbers: NNAP002

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No